title: Mild hypercalcemia: an indication to select 4-dimensional computed tomography scan for preoperative localization of parathyroid adenomas.
abstract: BACKGROUND
  Technetium sestamibi scanning is the most accepted method of imaging used for preoperative localization of parathyroid adenomas. Four-dimensional computed tomography (4D-CT) scanning is a relatively new localization technique that has not been as rigorously evaluated.
  
  
  METHODS
  One hundred thirty-five consecutive patients who underwent preoperative sestamibi scanning, 4D-CT scanning, and parathyroidectomy for primary hyperparathyroidism were evaluated. Patient characteristics, parathyroid gland weights, and the probability of having positive preoperative localization were examined.
  
  
  RESULTS
  Four-dimensional computed tomography scanning was significantly more accurate than sestamibi (73% vs 62%, P = .016). In those with serum calcium levels less than 10.8 mg/dL, 4D-CT scanning was significantly more accurate than sestamibi scanning for the quadrant (45% vs 29%, P = .013) and hemisphere (66% vs 48%, P = .012). Also, 4D-CT scanning was more accurate among patients with parathyroid gland weights less than 500 mg (69% vs 45%, P < .001).
  
  
  CONCLUSIONS
  Four-dimensional computed tomography scanning provides better preoperative localization than sestamibi scanning, particularly in patients with mild hypercalcemia and smaller parathyroid adenomas.
authors.affiliation: Henry Ford Hospital, Detroit, MI 48202, USA. leichho1@hfhs.org
authors.forename: Laura I
authors.initials: LI
authors.lastname: Eichhorn-Wharry
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Carlin
authors.forename: Gary B
authors.initials: GB
authors.lastname: Talpos
mesh_terms: D000236:Adenoma / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D014408:Biomarkers, Tumor / Q000097:blood*; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy; D057234:Preoperative Period; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi